Organization
MICHIGAN SPECIALTY CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FATINA MASRI MD (OWNER/PHYSICIAN)
(313) 945-9188
Entity
Organization
Contact information
Practice address
13530 MICHIGAN AVE, SUITE L2, DEARBORN, MI 48126-3574
(313) 945-9188
(313) 582-2545
Mailing address
13530 MICHIGAN AVE, SUITE L2, DEARBORN, MI 48126-3574
(313) 945-9188
(313) 582-2545
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23D21505179
CLIA OF REGISTRATION
MI
Enumeration date
03/27/2017
Last updated
03/10/2020
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